Healthcare Provider Details

I. General information

NPI: 1205735701
Provider Name (Legal Business Name): LOLIANO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3469 CHESTNUT LN
EAGAN MN
55123-1787
US

IV. Provider business mailing address

3469 CHESTNUT LN
EAGAN MN
55123-1787
US

V. Phone/Fax

Practice location:
  • Phone: 612-749-1957
  • Fax:
Mailing address:
  • Phone: 612-749-1957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JAIMELYN K PURVES
Title or Position: OWNER
Credential: MA, LPCC, LADC
Phone: 612-749-1957